Review: The Health of Nations–Infectious Disease, Environmental Change, and Their Effects on National Security and Development

5 Star, Complexity & Catastrophe, Disease & Health

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5.0 out of 5 stars Brings Deep Expertise Within Reach of the Public,

October 10, 2002
Andrew T. Price-Smith
The author is the student who excelled at the University of Toronto, where Thomas F. Homer-Dixon is a professor (and himself author of “Environment, Scarcity, and Violence”), and is now a professor at the University of Southern Florida.Although the Central Intelligence Agency got this right in the 1970’s, clearly warning U.S. policymakers that AIDS and related diseases were “the” catastrophic threat to national security and regional stability in the closing quarter of the 20th century, and although the United Nations and its various agencies have clearly understood the relationship between disease, environmental degradation, and instability–with all that instability brings in terms of crime, forced migration, and so on, the author gets five stars for doing an absolutely brilliant job of putting all of this knowledge–and his own original contributions–into a readable volume that can be understood by the most loosely-educated policymakers we have, as well as the voting public.

The author does a superb job of both crediting others (e.g. Laurie Garrett, whose stunning book “BETRAYAL OF TRUST: The Collapse of Global Public Health” we reviewed last year) while weaving his own insights into the story. ERIDs are “emerging and re-emerging infectious diseases.” They matter more now because, as the author summarizes it, modern man is in a very different situation today: “individuals can travel around the world rapidly by airplane, and overpopulation and the growth of megacities have created entirely new ‘disease pools’ that will allow new pathogens to emerge and flourish.”

The author has done a fine job of documenting how “human-induced worldwide environmental destruction” is both releasing pathogens from their hiding places in rain forests, launching new microbes that wreak havoc on aquatic life, and proliferating resistant strains of micobial terrorists we do not understand. Bacteria, in brief, are a thousand to a million times more deadly that any terrorist gang, and we would be wise to get our priorities straight as we set about pretending to govern.

As a general statement, the author appears to have done very very well as identifying intervening variables that could be analyzed, and his conclusions on what needs to be done are “President ready.” He not only makes his case, he ends by calling for a massive increase in “health intelligence,” and thereby demonstrates a wit lacking in most academics.

The notes are excellent, there is no bibliography, and the index is so mediocre it might as well not have been included–there is also no biography of this talented author, a grevious lack. The book should be reissued with this deficiencies being corrected.

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Review: Betrayal of Trust–The Collapse of Global Public Health

4 Star, Asymmetric, Cyber, Hacking, Odd War, Atlases & State of the World, Complexity & Catastrophe, Corruption, Culture, Research, Disease & Health

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4.0 out of 5 stars Way Too Long, But Someone Had To Write This Book,

November 15, 2000
Laurie Garrett

It took me over a month to do justice to this book, and I have taken into account the thoughts of other reviewers. A book of this importance would indeed have benefited from an international advisory board of public health, medical, insurance, and policy experts; it would certainly have benefited from greater structure, firmer editing, and a foreword by someone like a former Surgeon General of the United States. As it is, it appears to have overcome these deficiencies with hyped-up marketing and sweetheart reviews, and this in some ways counterproductive because this book could have, should have, become a mainstream topic in the Presidential campaign. It failed to do so for several reasons, not least of which is the propensity of both candidates and their advisors to avoid serious thinking, but also because the book is not helpful to a popular understanding of the very real global and domestic threats to the health of our children today and in future generations. Having said all this, I commend the book for its content and do not recommend it as avocational reading. There are some very important points that the book brings out, and I will itemize these in order of importance: 1) Public health is about detection and prevention, medicine is about remediation. In the long run, investments in public health are vastly cheaper and more effective than after-the-fact medical intervention; 2) The insurance industry in the developing world has failed to support public health investments, and in a remarkable collusion with the pharmaceutical, hospital and managed health care industries, has created a very expensive and increasingly ineffective system focused on drugs (to which diseases are increasingly resistant) and hospitals; 3) Hospitals are no longer reliable in terms of protecting patients from both error and secondary infection from other patients. People are coming out of hospitals, in many cases, with more diseases than when they went in; 4) The health of our nation depends on the health of all other nations-not only does a collapse of public health in Africa lead to failed states and forced migrations, but it also is but an airline flight away from infecting Kansas; 5) Clean drinking water, uninfected food, and good environmental and occupational health conditions are at risk in many parts of the United States and Europe, not only in Russia and the rest of the world; 6) The United Nations, and the World Health Organization in particular, are in disarray and ineffective-in large part because of a lack of support from member nations-at dealing with the public health commons. There is no question but that the author has hit a “home run” in terms of describing the harsh reality of epidemics in India and Africa, the collapse of public health in Russia, the rapid migration of many diseases from Russia through Germany to the rest of Europe and the U.S., and the severe costs in the U.S. of a retreat from the collective good with respect to public health. Unfortunately, it is a home run hit in isolation, not a game-winning home run, because it fails to drive home, to the only audience that matters-the U.S. voter-exactly what political and economic initiatives are required to achieve three simple objectives: 1) re-establish the public health infrastructure in the U.S.; 2) redirect the entire health care industry toward preventive measures-including water and food quality controls-instead of remedial prescriptions; and 3) provide compelling incentives to the rest of the world for cleaning their own house (this presumes that we are able to clean our own first, a very questionable assumption at this point in time). This is a valuable book, a five in terms of intent, a three in terms of execution, and I am glad that I took the time to read it. It provides a wonderful foundation for enjoying, at an intellectual and policy level, the medical and public health novels by Robin Cook.

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Review: Toxin (Fiction)

5 Star, Disease & Health, Threats (Emerging & Perennial)

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5.0 out of 5 stars Tells the Truth in an Engrossing Manner,

October 6, 2000
Robin Cook
If you’re the type of person that does not have the time to read Laurie Garrett’s BETRAYAL OF TRUST: The Collapse of Global Public Health (Hyperion, 2000), at 754 pages a real challenge, then this book, and the other books in the series, are a very worthwhile means of exploring real truths in an engrossing manner. The fact of the matter is that we are creating an increasingly dangerous environment for ourselves, with cross-contamination, increasingly resistant strains of difficult to diagnose diseases, and so on. The naive will lambast the book for scare-mongering, and they will be wrong–if this book gets you through an airline flight, or an afternoon, and causes you to think just a tiny bit about the reality that we can no longer trust our government to protect the food supply and preparation process, and to think just a tiny bit about how you might protect your children from inadequate “due diligence” by the food service industry, then you will be richly rewarded. The author himself recommends the non-fiction book by Nicols Fox, SPOILED: What is Happening to Our Food Supply and Why We Are Increasingly at Risk (Basic Books, 1997 or Penguin, 1998). The bottom line is that this novel is for serious people, and chillingly worthwhile for those who like to learn while being entertained.
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